RESUMO
OBJECTIVE: To determine the direct cost of complete cervical spinal cord injury. MATERIAL AND METHODS: 34 patients over 16 years of age with a diagnosis of complete cervical spinal cord injury. The cost calculation was done considering nine groups: bed days, specialty consultation, laboratory, X-rays, computed axial tomography, magnetic resonance imaging, anterior surgery, posterior surgery, anterior and posterior surgery. The micro costing technique was used and the mean cost per patient was obtained. RESULTS: 41% of patients had injury at C4-C5; mean age was 36 years; total cost was $8,622,793.00 mexican pesos, and the mean cost in patients who survived was $2,536,115.59 mexican pesos, which represented 29.4% of the total cost; the cost for the patients who died was $6,086,677.41 mexican pesos (70.6%). The percent distribution of the different components analyzed clearly shows that 51% of the total cost corresponded to hospitalization. The estimated annual cost of caring for these patients is $2,155,905.70 Mexican pesos, with an annual increase of $819,905.53 Mexican pesos. CONCLUSIONS: The major cost was hospitalization, so specific clinical management guidelines should be used to optimize economic resources and prevent complications that may increase the costs.
Assuntos
Traumatismos da Medula Espinal/economia , Adulto , Vértebras Cervicais , Custos e Análise de Custo , Custos Diretos de Serviços , Feminino , Humanos , MasculinoRESUMO
A spinal cord hemi-section with a homologous transplant of medullar tissue at the level of C5-C6 and preservation of the anterior spinal artery was used to evaluate the histological characteristics such as quantity and quality of axons, myelin index and blood vessels after quadriplegia recovery. Vascular changes after spinal injury results in severe endothelial damage, axonal edema, neuronal necrosis and demyelinization as well as cysts and infarction. Preservation of the anterior spinal artery has demonstrated clinical recuperation; therefore, in addition to the lesion we included a homologous transplant to visualize changes at a cellular level. Two groups of dogs (hemi-section and transplant) went through a traumatic spinal cord hemi-section of 50% at the level of C5-C6. The transplant group formed by animals which simultaneously had 4 mm of spinal cord removed and the equal amount substituted from a donor animal at the level of C5-C6 corresponding to the half right side; both preserving the anterior spinal artery. Histological evaluation of all groups took place at days 3 (acute) and 28 (chronic) post-operation. Changes of degeneration and axonal regeneration were found in the hemi-section and transplant groups at acute and chronic time, as well as same quadriplegia recovery at chronic time in the hemi-section and transplant groups which closely related to mechanisms which participate in regeneration and functional recuperation due to the preservation of the anterior spinal artery and presence of new blood vessels.
Assuntos
Regeneração Nervosa/fisiologia , Quadriplegia/cirurgia , Recuperação de Função Fisiológica/fisiologia , Traumatismos da Medula Espinal/cirurgia , Medula Espinal/transplante , Animais , Modelos Animais de Doenças , Cães , Masculino , Quadriplegia/fisiopatologia , Medula Espinal/irrigação sanguínea , Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/fisiopatologia , Transplante de Tecidos/métodosRESUMO
BACKGROUND: Risk factors are the endogenous or exogenous factors that may be controlled and they are responsible for disease. The objective of this paper is to describe the risk factors affecting vertebral fusion in patients with lumbar spine instability seen at our hospital and to see how they relate to nutritional factors. MATERIAL AND METHODS: Patients undergoing vertebral fusion due to several diagnoses were analyzed. Different parameters were captured to determine the interaction among them and assess the factors affecting vertebral fusion healing. They were compared with patients with pseudoarthrosis to determine its risk factors. Patients were divided into two groups: the control group, who underwent fusion, and the cases, who had pseudoarthrosis. RESULTS: A total of 59 patients were examined; 15 (25.4%) were cases (pseudoarthrosis) and 44 (74.6%) were controls (fusion). The demographic distribution was 27 (45.8%) females and 32 (54.2%) males; mean age was 51 +/- 12 years, with a minimum age of 20 and a maximum of 85. The diagnostic-based distribution was as follows: 29 (49.1%) spondylolistheses, 21 (35.6%) fractures, 5 (8.5%) herniated discs, 3 (5.1%) infections, and one (1.7%) tumor. Mean body weight was 75.9 kg, height was 160 cm, BMI 24.5, Hb 15.2, Hct 35.9, and Alb 3.5. Various risk factors were analyzed including the following: age over 60 years, which showed a 49% higher chance of pseudoarthrosis compared with the control group, with a 95% CI, 0.12-2.27; body weight over 90 kg, which showed an 82% higher chance of pseudoarthrosis compared with the fusion group, with a 95% CI, 0.03-0.43; BMI, which showed a 25% higher chance of pseudoarthrosis, with a 95% CI, 0.18-3.18; hypoalbuminemia < 3.4 mg/100 ml, which showed a 78% higher chance of pseudoarthrosis, with a 95% CI, 0.06-0.75. CONCLUSIONS: This study found that pseudoarthrosis is caused by risk factors linked to the nutritional profile, i.e., obesity, and hypoalbuminemia; its chance of occurring is 1.5 greater than in individuals with normal values. For this reason it is important to assess these values and correct them early on during the preoperative period with supportive measures allowing for an appropriate metabolic control and the consequent optimum result, i.e., fusion.
Assuntos
Instabilidade Articular/cirurgia , Vértebras Lombares/cirurgia , Fusão Vertebral , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Adulto JovemRESUMO
Two unrelated patients, aged 19 and 6 years, were studied and diagnosed as having Myhre syndrome (MS). This review, together with three previous cases, permits further delineation of MS. The main features are: short stature, mental retardation, blepharophimosis, muscular hypertrophy, decreased joint mobility, thick calvarium, broad ribs, hypoplastic iliac wings and short tubular bones. Advanced paternal age at the propositi's birth suggests an autosomal dominant mutation as the cause of MS.